Copyright 2011 Wolters Kluwer Health Lippincott Williams Wilkins

Chapter 09 Anxiety Disorders Copyright © 2011 Wolters Kluwer Health | Lippincott Williams &

Anxiety Defined • Vague, uneasy, emotional feeling normally experienced in response to perceived threat

Anxiety as a Symptom • Free-floating anxiety – Person unable to connect the anxiety

Anxiety Disorders • Uncontrolled, overwhelming anxiety • Impaired functioning – Personal – Social –

Panic Disorder • Panic attack – Most often in Females in late adolescence or

Agoraphobia • Avoid places or situations that trigger panic attack • Restrict activities to

Phobia • Specific phobia – An excessive and persistent irrational fear of specific objects

Obsessive-Compulsive Disorder • Obsession – Recurrent, persistent, unwanted thoughts or images causing intense anxiety

Posttraumatic Stress Disorder (PTSD) • Response to a situation involving actual death or threat

Generalized Anxiety Disorder • Increased level of anxiety and worry about various situations on

Treatment of Anxiety Disorders • Focus is to reduce the anxiety level • Medications

Nursing Process Applied • Take steps to lower the anxiety level; encourage the client’s

Nursing Process Applied (Cont. ) • Nursing diagnoses Pg. 133 • Expected outcomes Pg.

Nursing Process Applied (Cont. ) • Interventions – Consider how your own anxiety may

Nursing Process Applied (Cont. ) • Evaluation – Client’s ability to recognize and deal

Question • Tell whether the following statement is true or false. The obsession aspect

Answer • False • Rationale: Obsession refers to recurrent, persistent, unwanted thoughts or images

Question • Which disorder is characterized by mental reruns of an event, emotional numbness,

Answer • D. Posttraumatic stress disorder • Rationale: A person with posttraumatic stress disorder

Question • Tell whether the following statement is true or false. A person suffering

Answer • True • Rationale: A person with agoraphobia often chooses to remain in

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Anxiety Defined • Vague, uneasy, emotional feeling normally experienced in response to perceived threat or danger • An uncomfortable, fear Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Anxiety as a Symptom • Free-floating anxiety – Person unable to connect the anxiety to a stimulus • Thoughts, feelings, behaviors – All affected as anxiety increases • Automatic relief behaviors – Clenching jaws, tapping fingers, fidgeting • Unrelieved anxiety over time leads to disorder Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Panic Disorder • Panic attack – Most often in Females in late adolescence or mid 30 s – Sympathetic Nervous System Responses • Rapid heartbeat • Increased perspiration • Chilling/numbness • Nausea • Feeling of suffocation • Chest pain/fear of heart attack • Fear of being out of control Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Agoraphobia • Avoid places or situations that trigger panic attack • Restrict activities to avoid recurrence of symptoms • Often homebound or restricted to home environment • Unemployment or school dropout common Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Phobia • Specific phobia – An excessive and persistent irrational fear of specific objects or situations that actually pose little threat or danger • Animals, heights, water, storms, blood, needles, flying, elevators, tight spaces, etc. • Social phobia – Excessive fear of any social situation in which embarrassment is possible • Intense discomfort when being watched Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Obsessive-Compulsive Disorder • Obsession – Recurrent, persistent, unwanted thoughts or images causing intense anxiety • Compulsion – Repetitive behavior engaged in to reduce high level of anxiety • http: //www. youtube. com/watch? v=d. SZNnz 9 SM 4 g • http: //www. youtube. com/watch? v=C 3 pl 7 Psb 5 ic Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Posttraumatic Stress Disorder (PTSD) • Response to a situation involving actual death or threat of injury • Intense feeling or fear and dread following an event • Mental reruns of an event • Emotional numbness • Avoidance of people and places associated with an event • Insomnia, inability to concentrate, impaired social or work functioning • http: //www. youtube. com/watch? v=tqxi. Ee 0 RH-Y Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Generalized Anxiety Disorder • Increased level of anxiety and worry about various situations on most days over a period of at least 6 mo • Chronic worry/anxiety • Negative self-talk • Fatigue • Difficulty falling/staying asleep • Muscle Tension • Anticipating the “worst” • Irritability, headaches, tremors • Physical symptoms Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Treatment of Anxiety Disorders • Focus is to reduce the anxiety level • Medications – Antianxiety (Anxiolytics) drugs – Greatest success in combination with psychotherapy • Psychotherapy – Cognitive-behavioral therapy – Anxiety support groups Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing Process Applied • Take steps to lower the anxiety level; encourage the client’s trust (reduce triggers) • Assessment – Current feelings – What happened immediately prior to the onset of symptoms (use direct questioning) – Client’s perspective on the situation – Thought processes – Communication ability, thought blocking – Affect, expression, nonverbal behaviors Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing Process Applied (Cont. ) • Interventions – Consider how your own anxiety may affect nursing care – Should be timely, client centered, and realistic (small steps) – Help the client try more adaptive coping strategies – Establish a sense of trust Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question • Tell whether the following statement is true or false. The obsession aspect of obsessive-compulsive disorder refers to repetitive behavior. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question • Which disorder is characterized by mental reruns of an event, emotional numbness, and/or avoidance of people and places associated with the event? A. Agoraphobia B. Obsessive-compulsive disorder C. Generalized anxiety disorder D. Posttraumatic stress disorder E. Panic disorder Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer • D. Posttraumatic stress disorder • Rationale: A person with posttraumatic stress disorder experiences mental reruns, numbness, and avoidance of people and places associated with an event; the disorder usually occurs following a situation that involves a death or a threat of a severe injury. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins